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Notes for: Skin
Last edited [16/11/2021 14:55:40]


NHS Kernow emollient prescribing guideline September 2021

NHS Kernow moisture associated skin damage pathway September 2021

Fire risk with paraffin-containing products


Management of skin conditions

    With skin disease it is extremely important to consider patient acceptability of a product to maximise patient compliance. There is a wide range of products available and patient acceptance of individual products is very variable.
    Where a consultant or GP with specialist interest asks a GP to prescribe a non-formulary agent they should check that formulary agents have been tried and not tolerated by the patient

    Greasy preparations (ointments) are often preferable to creams in most circumstances because:

    • They contain fewer skin sensitisers
    • They are more hydrating (ie water retaining)
    • There is better penetration of active ingredients

    However, patient preference or activity may necessitate a combination of ointments and creams, for example, patients may prefer to apply creams during the day and use ointments at night, or different preparations on different parts of the body.

    Application technique: It is important to educate patients with the correct application technique. Ointments and creams should be applied down the direction of hair growth. They should also be smeared on and not rubbed in.

    Pot Hygiene: When supplying patients with pots of emollient, it is important to educate them about the hygiene required. Patients should be advised to decant from the pot onto plate/bowl etc. using a spoon or a spatula. Hands should not be put into the pot as this will lead to the introduction of foreign particles.

    In many cases generic prescribing will be difficult because products contain a combination of active ingredients. In this chapter brand names are used for products which should not be prescribed generically.

    Extemporaneous preparations: A product should only be extemporaneously prepared when there is no product with a marketing authorisation available. Depending on the formulation this may be done in a pharmacy, or by a specials manufacturer, usually depending on the formulation. Where a specials manufacturer prepares the product, additional charges will be incurred. The cost can, and usually does, exceed £100 for a cream. The cost is usually the same whether 500 g or 50 g of a product is ordered. Specials all have a very short shelf life with an expiry date of a maximum of 28 days from manufacture.

    A range (but not all) of specials preferred by the British Association of Dermatologists has been approved for use within Cornwall & IoS mainly for prescribing by secondary care. The website also lists various clinical guidelines.



     

    Cornwall Joint Formulary Recommended Choices     (...Top)
    Displaying 13 Drugs

    Key:
    First Line Drugs First Line Drugs
    Second Line Drugs Second Line Drugs
    Specialist Initiated Drugs Specialist Initiated Drugs
    Hospital Only Drugs Hospital Only Drugs
    Discouraged Discouraged
    No comment available No comment available
    Antibiotics Antibiotics

    NameTariffBNF Sub Paragraph
    Benzoyl Peroxide Aqueous Gel (Panoxyl Aquagel)
    2.5 % in 40g tube Pack of 40
    £1.76PCT FORMULARY STATUS: First Line Drugs Topical Preparations For AcneView BNF Article on 'Benzoyl Peroxide Aqueous Gel'View SPC on 'Benzoyl Peroxide Aqueous Gel'View PIL on 'Benzoyl Peroxide Aqueous Gel'
    Benzoyl Peroxide (Panoxyl)
    5 % Cream in 40g tube Pack of 40
    £1.89PCT FORMULARY STATUS: First Line Drugs Topical Preparations For AcneView BNF Article on 'Benzoyl Peroxide'View SPC on 'Benzoyl Peroxide'View PIL on 'Benzoyl Peroxide'
    Benzoyl Peroxide Aqueous Gel (Panoxyl Aquagel)
    5 % in 40g tube Pack of 40
    £1.92PCT FORMULARY STATUS: First Line Drugs Topical Preparations For AcneView BNF Article on 'Benzoyl Peroxide Aqueous Gel'View SPC on 'Benzoyl Peroxide Aqueous Gel'View PIL on 'Benzoyl Peroxide Aqueous Gel'
    Benzoyl Peroxide Aqueous Gel (Panoxyl Aquagel)
    10 % in 40g tube Pack of 40
    £2.13PCT FORMULARY STATUS: First Line Drugs Topical Preparations For AcneView BNF Article on 'Benzoyl Peroxide Aqueous Gel'View SPC on 'Benzoyl Peroxide Aqueous Gel'View PIL on 'Benzoyl Peroxide Aqueous Gel'
    Benzoyl Peroxide Cream (Quinoderm Cream)
    5 % cream Pack of 50
    £2.43PCT FORMULARY STATUS: First Line Drugs Topical Preparations For AcneView BNF Article on 'Benzoyl Peroxide Cream'View SPC on 'Benzoyl Peroxide Cream'View PIL on 'Benzoyl Peroxide Cream'
    Clindamycin Solution (Dalacin T Solution)
    1 % (10mg/ ml) Pack of 30
    £4.34PCT FORMULARY STATUS: First Line Drugs [Notes:] Alcoholic basis Topical Preparations For AcneView BNF Article on 'Clindamycin Solution'View SPC on 'Clindamycin Solution'View PIL on 'Clindamycin Solution'
    Alcoholic basis
    Clindamycin (Dalacin T Topical Lotion)
    1 % (10mg/ ml) Pack of 30
    £5.08PCT FORMULARY STATUS: First Line Drugs [Notes:] Aqueous basis Topical Preparations For AcneView BNF Article on 'Clindamycin'View SPC on 'Clindamycin'View PIL on 'Clindamycin'
    Aqueous basis
    Adapalene (Differin)
    0.1 % gel Pack of 30
    £6.86PCT FORMULARY STATUS: First Line Drugs Topical Preparations For AcneView BNF Article on 'Adapalene'View SPC on 'Adapalene'View PIL on 'Adapalene'
    Adapalene (Differin)
    0.1 % cream Pack of 30
    £6.86PCT FORMULARY STATUS: First Line Drugs Topical Preparations For AcneView BNF Article on 'Adapalene'View SPC on 'Adapalene'View PIL on 'Adapalene'
    Azelaic Acid Topical Gel (Finacea)
    15 % Gel (30g Unit) Pack of 30
    £7.48PCT FORMULARY STATUS: First Line Drugs [Notes:] Papulopustular rosacea - discontinue if no improvement after 1 month  Topical Preparations For AcneView BNF Article on 'Azelaic Acid Topical Gel'View SPC on 'Azelaic Acid Topical Gel'View PIL on 'Azelaic Acid Topical Gel'
    Papulopustular rosacea - discontinue if no improvement after 1 month
    Erythromycin Solution (Zineryt)
    40 mg / ml (30ml Unit Powder & Alcohol Solvent) Pack of 30
    £9.25PCT FORMULARY STATUS: First Line Drugs Topical Preparations For AcneView BNF Article on 'Erythromycin Solution'View SPC on 'Erythromycin Solution'View PIL on 'Erythromycin Solution'
    Benzoyl Peroxide / Clindamycin (Duac Once Daily Gel)
    1 % & 5% Gel Pack of 25
    £10.95PCT FORMULARY STATUS: First Line Drugs Topical Preparations For AcneView BNF Article on 'Benzoyl Peroxide / Clindamycin'View SPC on 'Benzoyl Peroxide / Clindamycin'View PIL on 'Benzoyl Peroxide / Clindamycin'
    Ivermectin (Soolantra)
    10 mg/g cream Pack of 30
    £18.29PCT FORMULARY STATUS: Second Line Drugs [Notes:] Mild papulopustular rosacea is usually managed by azelaic acid 15% gel. For moderate to severe inflammatory lesions of rosacea where a topical treatment is appropriate, ivermectin 1% cream should be used instead of topical metronidazole. Systemic antibiotics are reserved for more severe disease. Topical Preparations For AcneView BNF Article on 'Ivermectin'View SPC on 'Ivermectin'View PIL on 'Ivermectin'
    Mild papulopustular rosacea is usually managed by azelaic acid 15% gel. For moderate to severe inflammatory lesions of rosacea where a topical treatment is appropriate, ivermectin 1% cream should be used instead of topical metronidazole. Systemic antibiotics are reserved for more severe disease.

     
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